Eradication of Carbapenem-Resistant Klebsiella Pneumoniae Gastrointestinal Colonization and Prevention of Secondary Bloodstream Infections with Oral Colistin

Infections caused by Carbapenem-Resistant Klebsiella Pneumoniae [CRKP] are common, difficult to treat with extremely limited antimicrobial options, and are associated with high mortality. The prevalence of these infections is rising in Oman and present an everyday clinical challenge to patients, physicians, and health systems alike. CRKP carriers represent an epidemiological threat to other hospitalized patients and to the whole community but are also at risk of developing clinical consequences of this colonization, including bloodstream infections from these pathogens. The gastrointestinal tract is considered a key reservoir of CRKP. Infections caused by CRKP are frequently preceded by intestinal colonization. In fact, intestinal colonization is a key factor for developing infection especially in specific situations such as patients in the intensive care units and the immunocompromised patients. Additionally, an association between colonization and mortality has recently been demonstrated. Decolonization therapy [DT] using oral non-absorbable antibiotics has been tested as a measure to control the transmission of these organisms and might be useful as a tool for preventing infections by CRKP in high-risk situations. However, there is limited data on the efficacy and safety of selective intestinal decolonization by Colistimethate sodium (colistin) in high-risk adult patients. This study aims to examine the impact of DT using oral colistin on the eradication of CRKP and prevention of invasive bloodstream infection by this organism.